UK: NIHR funding opportunity: 22/37 Non-pharmacological interventions for fatigue management in adults with long-term health conditions

Andy

Andy

Retired committee member
Introduction
The aim of the Health Technology Assessment (HTA) Programme is to ensure that high quality research information on the clinical effectiveness, cost-effectiveness and broader impact of healthcare treatments and tests are produced in the most efficient way for those who plan, provide or receive care from NHS and social care services. The commissioned workstream invites applications in response to calls for research on specific questions which have been identified and prioritised for their importance to the NHS, patients and social care.

Research question
What is the clinical and cost-effectiveness of non-pharmacological interventions and strategies for the management of fatigue in people with long-term physical and/or mental health conditions?

  • Intervention: Non-pharmacological fatigue management interventions and strategies.
  • Patient group: Adults with one or with multiple long-term physical and/or mental health conditions.
    (The following conditions are covered elsewhere - cancer, long-COVID, post-viral fatigue, medically not yet explained conditions, acute conditions resulting from accidents or injuries, and developmental disorders).
  • Setting: Any setting.
  • Study design: Evidence synthesis through a comprehensive review of the available evidence, including quantitative, qualitative and other relevant research. Applicants should suggest and justify the most appropriate methods for the evidence synthesis.
  • Important outcomes: A synthesis of the existing evidence and recommendations for the design of future research.
  • Other outcomes and outputs to consider: Facilitators and barriers to uptake of interventions; fatigue and other health-related quality of life measures; healthcare resource use; identification of promising interventions and components of interventions that could be tested further; recommendations for possible future primary research (including questions focused on under-researched populations). Applicants should consider whether a cost effectiveness evaluation would be contributory. Meta-analysis and subgroup analyses should be undertaken as appropriate. Existing Core Outcomes should be included amongst the list of outcomes unless a good rationale is provided to do otherwise. Applicants are encouraged to report recruitment and findings disaggregated by sex (and other demographic factors where relevant).
https://www.nihr.ac.uk/documents/22...adults-with-long-term-health-conditions/30105
 
Oh, they know that they work already, it's just a question of how much further they can be applied. (and how they might be tweaked to be more effective)
There is evidence of benefit from some non-pharmacological interventions, such as physical activity and cognitive approaches in some conditions, but effectiveness is variable. Recent research has usually been disease specific. Consequently, it is not known whether currently available fatigue management interventions are beneficial to specific conditions only, or whether there are key elements of fatigue management that are effective across long-term conditions or subgroups of conditions
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Excuse my skepticism, but this looks like the psychosomatic gravy train rolling on. In fact, it's probably more like a steam roller, with the NICE ME/CFS guideline, the Long Covid guideline and others sitting like cupcakes on the road ahead:
The HTA Programme wishes to fund the study outlined above to synthesise the available evidence across long-term physical and mental health conditions, and to inform clinical practice, patient choice, and future guidelines.
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The deadline for submission of a proposal is September. It would be terrific to see an unbiased team apply, although probably a futile gesture.

A background document is available that provides further information to support applicants for this call. It is intended to summarise what prompted the call and the existing evidence base, including relevant work from the HTA Programme and wider NIHR research portfolio. It was researched and written on the basis of information from a search of relevant sources and databases, and in consultation with a number of experts in the field. If you would like a copy please email htaresearchers@nihr.ac.uk.
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Scepticism is certainly justified - I wonder however whether this is not a political move "away" from the failed CBT/GET focus rather than a retrenchment into it.

If the NIHR is true to its word https://www.s4me.info/threads/uk-be...-address-nice-research-recommendations.24954/ and is going to set NICE research recommendations securely within the NIHR programme then the NIHR needs to have a way forward that takes the 2021 NICE ME/CFS guideline recommendations into account. This funding "could" be the commission that provides a route map.

Not that I'd expect any new routes to be uncontested.
 
The approach is just plain stupid. If you ask for people who are interested in doing a review of the effectiveness of X you will get applications from people who have a vested interest in showing the effectiveness of X. Anyone with a reasonable degree of scepticism and at least minimal knowledge of the field will be aware that there is nothing worth reviewing.

And why lump together non-pharmacological interventions anyway?
 
This is entirely useless. A huge grab bag of random things with no discernible overlap, both in terms of the treatments and the conditions. It doesn't even make sense to begin with, is a complete misunderstanding of what patients mean by fatigue, and lumping many various concepts thrown in the kitchen sink that is now the medical definition of fatigue makes even less sense.

The very idea that you can take the consequences of illness, alone and detached from the illness itself, and treat it is nonsense. The vast majority of drugs simply mitigate or lessen the symptoms of illness, usually at the cost of other issues, they rarely actually treat them. Especially with the most common symptoms. This whole circus has left obsession behind and accelerated straight into fanaticism.
Recent research has usually been disease specific
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This is completely false. All BPS research of this type explicitly don't bother with specific diseases, they are as vague and generic as they can be precisely because it allows complete ambiguity.

It's literally currently litigious over the entirety of the "chronic fatigue" BPS pseudoresearch that they only ever use the mere presence of something that can be labeled as fatigue, from people whose main goal is literally to de-medicalize those diseases, they literally don't believe they exist, how can this research be "disease specific"?
 
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"UK: NIHR funding opportunity: 22/37 Non-pharmacological interventions for fatigue management in adults with long-term health conditions"

I laughed when I read the title. Perhaps someone like @Brian Hughes Could consider whether anything meaningful (like funding for an MSc project) could come out of this.

All NIHR have to do is get someone to read Brian' blogs.
 
I've received a copy of the 10 page Commissioning Brief - Background Information, attached here (there does not seem to be any constraint on posting it).

This background document provides further information to support applicants for this call. It is intended to summarise what prompted the call and the existing evidence base, including relevant work from the HTA and wider NIHR research portfolio. It was researched and written on the basis of information from a search of relevant sources and databases, and in consultation with a number of experts in the field. Searches and information provided were up to date as of January 2022.
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A. It includes summaries of a number of studies on various specific health conditions e.g.

Effects of Mindfulness-based interventions on physical symptoms in people with multiple sclerosis - a systematic review and meta-analysis (Simpson 2020, UK, University of Glasgow)7

Objective: To update a previous systematic review (2014) and conduct a meta-analysis on the efficacy of Mindfulness-based interventions for improving physical symptoms in people with multiple sclerosis.
Searches: Up to July 2018.

Studies: Ten randomised controlled trials were included (678 participants). Seven of these (555 participants) were used in the meta-analysis.
Interventions: Mindfulness-based interventions included manualised and tailored interventions, treatment duration 6-9 weeks, delivered face-to-face and online in groups and also individually. Conclusion: Mindfulness-based interventions appear to be an effective treatment for fatigue in people with multiple sclerosis. The optimal Mindfulness-based intervention in this context remains unclear.
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Effects of cognitive behavioral therapy for patients with rheumatoid arthritis: a systematic review and meta-analysis (Shen 2020, China)15

Objective: To assess the effects of cognitive behavioural therapy on the psychological and physiological health of rheumatoid arthritis patients.
Searches: Up to December2018.
Studies: Six randomized controlled trials were included.

Conclusion: Cognitive behavioural therapy could significantly reduce levels of anxiety and depression, and relieve fatigue symptoms in rheumatoid arthritis patients.
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Effectiveness of Nonpharmacologic Interventions for Decreasing Fatigue in Adults With Systemic Lupus Erythematosus: A Systematic Review (del Pino-Sedeno 2016, Spain)21

Objective: Non-pharmacologic strategies seem regularly utilized for fatigue management in SLE; however, their real effects are not known.
Searches: up to June 2014
Studies: Twelve studies were included (549 participants); seven randomized trials, 1 nonrandomized trial, and 4 prospective observational studies.

Interventions: Five main intervention categories: exercise, behavioural and psychological approaches, diets, acupuncture, and phototherapy.
Conclusions: All interventions produced reductions in fatigue. Studies were few and heterogeneous; however, non-pharmacologic interventions applied to systemic lupus erythematosus patients can be effective in reducing fatigue
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ME/CFS and indeed anything that usually falls in the MUS bucket is not mentioned.

I assume these studies largely involve subjective outcomes with unblinded treatments when it comes to assessing fatigue.

B. Then there was a list of relevant studies currently in progress - again no MUS.

C. And then there was a list of NIHR funded studies - there was only one MUS type study, the rest being on a range of non-MUS diseases such as cancer, sickle cell anaemia and arthritis. There was also a general CBT review.

HTA 15/174/24: Cognitive Behavioural Therapy: An overview of systematic reviews and meta- analyses. Published.
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HEE/NIHR Integrated Clinical Academic Programme ICA-CL-2015-01-019: Developing an activity pacing framework for the management of chronic pain/fatigue. Deborah Antcliff, Pennine Acute Hospitals NHS Trust. Completed award.
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D. and then it closed with just this

Research following patient need

Applicants are encouraged to include geographic populations with high disease burden which have been historically underserved by research activity in this field in order to ensure that NIHR research is conducted in the areas where health needs are greatest. We would encourage applicants to bring on one or two centres with high disease burden that have been relatively inactive in this area to date.
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As a background briefing paper, it does not seem very adequate, particularly given the broad scope of this funding opportunity (e.g. the call covers mental health, but no research about fatigue in mental health conditions is mentioned).
 

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